AMCHP 2005 ANNUAL CONFERENCE
DELIVERING RESULTS, IMPROVING PREGNANCY & BIRTH
February 19-23, 2005
KATHLEEN BUCKLEY: But I think we have to think about that FIMRs are of great benefit to states in understanding local issues and local problems and helping them develop a statewide Title V needs assessment as well.
And we also should understand that population based data tells you what the problems are, but does not always point to culturally relevant and locally credible interventions. FIMR is that link.
I wanted to give you an example of ways where I learned that where FIMR and Title V are mutually beneficial. And some of this comes from my hat where I am the FIMR director, but some comes from my experience from 1988 to 1994 being a FIMR coordinator in a large state.
Ways that FIMR can benefit Title V. One: An issue or a need identified by several very different local FIMRs in the same state may point to a need for statewide policy and program development or even a new law.
In one state, several FIMR programs documented the need for prenatal health education program and that state, working with the March of Dimes and communities of color created a statewide initiative to increase health education for mom's.
Second: Unique findings from one particular FIMR community may provide insights that enhance the ability of State Title V to provide technical assistance or provide funding to it.
In one county the FIMR finding suggested that mom's released from prison were at very high risk. There weren't very many of them, but they were falling through the gaps and not being found. At the same time the FIMR team found that they had community health workers who targeted Hepatitis B moms. Community health workers who targeted HIV moms, and community health workers who targeted moms with TB. So what they decided was with the help of a Title V director they would cross-train the community directors, decrease the overlap in community health worker visits, and at the same time provide resources for those moms released from prison and that worked very well.
Three: Findings from local FIMRs may shed light on how state funded or federally funded programs mesh at the local level. Things look good on paper, but at the community level things sometimes don't work out that well. And in one case a county had two federally funded resource to provide coordination of care for high risk Native American newborns. But those two agencies were not necessarily on the same page and the local county Health Department also had different priorities. So with the help of state Title V, they were able to come together and make the services really work. And now, in that county, every Native American newborn has a discharge plan before they leave the hospital.
Number four: FIMR vignettes or family stories provide a human face about disparities that might clarify population based data and lead to new culturally appropriate locally significant strategies to address the issue.
In one county, the prematurity rates were five times higher for African American moms than they were for white moms. And what the county found, they were all set to go into that community and get moms to enroll in perinatal care early. But what they found was nobody in that community understood that they had that problem. It wasn't only the child bearing families, it was the business leaders, the religious leaders, the community advocates. No one understood the problem so they had to take a step back before they could go forward and work with the community to help them understand that this was their issue that they needed to address. And how they did that was they worked with the local churches and had those leaders talk to the community about what was being found. And I know I'm preaching to the choir here, but when you find that, FIMRs are telling us that you need to take the step back and not implement evidence based interventions right away, but you have to have the community on the problem right away and then you can move forward.
And finally from my own experience as the State FIMR coordinator, I noticed this wonderful thing after years of working and getting FIMR off the ground, we finally had information from 650 cases. It was all there in paper and it was all on the computer and I began to notice that folks in the commissioners office would begin to call the Title V director and say, you know, say, can you just tell me, can you look through your records and let me know about this piece of data, and that piece of data. FIMR is a rich data source and when folks understand it's power, it brings acknowledgment to state Title V, I think, and everyone will use it.
So what we say is that FIMR program -- the FIMR program relationship is one that could be institutionalized through the State Title V needs assessment and the performance measures requirements, and it would be mutually beneficial to both.
Now, finally, as a part of the national evaluation of FIMR. State Title V coordinators from Florida, Virginia, Minnesota, California, Arkansas, Maryland, South Carolina, New Jersey and Alaska sat down with the researchers from John's Hopkins and told them about their experience and made recommendations for the future. And what they said, and I'm quoting from this article is this: I would like to leave you with a conclusion -- oh.
Since 1989, State Title V programs have been required to conduct comprehensive needs assessments for their maternal and child health populations every five years. FIMR program findings should be used to inform the needs assessment contributing to a more strategically design programs aimed at improving perinatal health services system wide. Thank you.